Podiatry Coding & Billing Alert

Look for different sessions or sites before you try to break these bundles.

If your podiatrist is performing venous compressions, you may already know about new procedure code 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed), introduced in CPT® 2012. And now you need to know how that code is affected by the latest round of Correct Coding Initiative (CCI) edits, effective January 1, 2012.

According to CCI 18.0, 29582 is bundled into all "Fracture and/or Dislocation Procedures on the Foot and Toes" codes (28400-28675). It is also considered an intrinsic part of these codes:

• 28001 -- Incision and drainage, bursa, foot
• 28002 -- Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space
• 28124 -- Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (e.g., osteomyelitis or bossing); phalanx of toe
• 28234 -- Tenotomy, open, extensor, foot or toe, each tendon
• 28238 -- Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (e.g., Kidner type procedure)
• 28240 -- Tenotomy, lengthening, or release, abductor hallucis muscle
• 28250 -- Division of plantar fascia and muscle (e.g., Steindler stripping) (separate procedure)
• 28285 -- Correction, hammertoe (e.g., interphalangeal fusion, partial or total phalangectomy)
• 28292 -- Correction, hallux valgus (bunion), with or without sesamoidectomy; Keller, McBride, or Mayo type procedure
• 28310 -- Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure).

Code 29581 (Application of multi-layer compression system; leg [below knee], including ankle and foot) is also bundled into these same codes. CPT® revised the code description for 2012 to specify that the procedure includes the ankle and foot.

The venous compressions are done for varicose veins, postphlebitis syndrome, atherosclerosis, chromic venous hypertension, or stasis ulcers in the limb(s).

Unbundling opportunity: These bundles are all marked with modifier indicator "1," which may allow you to break the bundle. In certain clinical circumstances you can override -- not ignore -- CCI edits and receive separate payment for bundled codes. To find out if you can separately bill services, first check the "modifier indicator" in column F of the CCI spreadsheet.

How it works: "All edits consist of code pairs that are arranged in two columns (Column 1 and Column 2),"explains Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, consultant with MJH Consulting in Denver. "Codes that are listed in Column 2 are not payable if performed on the same day on the same patient by the same provider as the code listed in Column 1, unless the edits permit the use of a modifier associated with CCI."

A "0" indicator means that you cannot unbundle the two codes under any circumstances. An indicator of "1," however, means that you may use a modifier to override the edit if the clinical circumstances warrant separate payment.

Tip: The most common modifiers that Part B practices use to override an edit pair are 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) when used with an associated E/M code, or modifier 59 (Distinct procedural service) when two non-E/M services are performed and no other modifier is available to report the two separate and distinct services, says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director of Network Oversight at Mount Sinai Medical Center Compliance Department in New York City. "Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual," she says. "However, when another already established modifier is appropriate, it should be used rather than modifier 59."

For more on CCI edits and to find which ones impact your practice, visit the CMS website at www.cms.gov/nationalcorrectcodinited/ncciep/list.asp.